Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2025; 31(8): 98415
Published online Feb 28, 2025. doi: 10.3748/wjg.v31.i8.98415
Carbapenem-resistant Klebsiella pneumoniae infections after liver transplantation: Drug resistance, risk factors and impact on prognosis
Tao-Hua Liu, Li-Hua Chen, Qi-Quan Wan
Tao-Hua Liu, Department of Pediatrics, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
Li-Hua Chen, Department of Laboratory Medicine, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
Qi-Quan Wan, Department of Transplant Surgery, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
Qi-Quan Wan, Engineering and Technology Research Center for Transplantation Medicine of National Health Commission, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
Author contributions: Liu TH collected data, analyzed data, and drafted manuscript; Chen LH analyzed data and revised the manuscript; Wan QQ designed the study, supervised the study, and revised the manuscript; and all authors have reviewed and approved the final manuscript.
Supported by the Open Research Fund of Hunan Provincial Key Laboratory of Regional Hereditary Birth Defects Prevention and Control, No. HPKL2023031.
Institutional review board statement: This study was approved by the Ethics Committee of the Third Xiangya Hospital (approval No. 24029), and adhered to the principles of the Declaration of Helsinki.
Informed consent statement: Patients were not required to provide informed consent for this study because the analysis used anonymous clinical data.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The data to support the findings of this study are available from the corresponding author upon request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qi-Quan Wan, Associate Professor, MD, Department of Transplant Surgery, The Third Xiangya Hospital of Central South University, No. 138 Tongzipo Road, Changsha 410013, Hunan Province, China. 13548685542@163.com
Received: June 25, 2024
Revised: December 11, 2024
Accepted: January 6, 2025
Published online: February 28, 2025
Processing time: 211 Days and 10.7 Hours
Abstract
BACKGROUND

Liver transplant (LT) recipients are susceptible to carbapenem-resistant Klebsiella pneumoniae (CRKP) infections. Comprehensive research addressing the incidence, timing, infection sites, resistance patterns, treatment options, and associated risk factors among LT recipients with CRKP is now lacking.

AIM

To assess the incidence, resistance, therapy, and risk factors of CRKP infections post-LT, and to evaluate the impact of them on prognosis.

METHODS

A retrospective study was conducted, including 430 consecutive patients who underwent LT between January 2015 and June 2023. This study aimed to investigate the risk factors for CRKP infections and their influence on outcomes using logistic regression analysis.

RESULTS

Among the 430 patients who underwent LT, 20 (4.7%) experienced at least one documented CRKP infection within 3 months post-transplantation. The median time from LT to the onset of CRKP infections was 6.5 days. The lungs and bloodstream were the most common sites of CRKP infections. CRKP isolates were relatively susceptible to ceftazidime/avibactam (93.7%), polymyxin B (90.6%), and tigecycline (75.0%) treatment. However, all isolates were resistant to piperacillin/tazobactam, ceftazidime, cefepime, aztreonam, meropenem, and levofloxacin treatment. Recipients with CRKP infections had a mortality rate of 35%, the rate was 12.5% for those receiving ceftazidime/avibactam therapy. Multivariate analysis identified female sex [odds ratio (OR) = 3.306; 95% confidence interval (CI): 1.239-8.822; P = 0.017], intraoperative bleeding ≥ 3000 mL (OR = 3.269; 95%CI: 1.018-10.490; P = 0.047), alanine aminotransferase on day 1 post-LT ≥ 1500 U/L (OR = 4.370; 95%CI: 1.686-11.326; P = 0.002), and post-LT mechanical ventilation (OR = 2.772; 95%CI: 1.077-7.135; P = 0.035) as significant variables associated with CRKP. CRKP infections were related to an intensive care unit length (ICU) of stay ≥ 7 days and 6-month all-cause mortality post-LT.

CONCLUSION

CRKP infections were frequent complications following LT, with poor associated outcomes. Risk factors for post-LT CRKP infections included female sex, significant intraoperative bleeding, elevated alanine aminotransferase levels, and the need for mechanical ventilation. CRKP infections negatively impacted survival and led to prolonged ICU stays.

Keywords: Liver transplantation; Carbapenem-resistant Klebsiella pneumonia; Antibiotic resistance; Infection; Immunosuppression; Risk factors

Core Tip: Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections were frequently seen in liver transplant recipients. CRKP isolates were relatively susceptible to ceftazidime/avibactam and polymyxin B. Risk factors for CRKP infections included female sex, significant intraoperative bleeding, elevated alanine aminotransferase levels, and the need for mechanical ventilation. CRKP infections negatively impacted survival and led to prolonged intensive care unit stay.